This month the Compliance Office gave out awards to two individuals who demonstrated diligence in their efforts with medical billing compliance. Clarence Sasaki, M.D. Chief of Otolaryngology, was cited for excellence in documentation in the use of modifier 22. Modifier 22 is used for those procedures where the service provided is greater than is usually required for the listed procedure code. Insurers may reimburse modifier 22 services at an increased rate if the documentation supports the additional work effort. Dr Sasaki's documentation in the operative note includes his rationale as to why modifier 22 is appropriate.
John Spiteri, an account assistant in the Pediatrics Emergency Room, was selected based on his careful attention to entering billing information into IDX with a high degree of accuracy. Mr. Spiteri also reviews other aspects of the claim such as Medicode edits and physician signatures to ensure that the Pedi ER billings contain the required components necessary for reimbursement. The recipients received a gift certificate to Union League Café a popular local restaurant. Recommendations for next year's recipients should be sent to Judy Harris at judy.harris@yale.edu.
Submitted by YSM Web Group on July 23, 2012